Rationale: Cardiac disease is extremely common in the ESRD population and accounts for 50% of all deaths. Hypertension is one of the major risk factors for cardiac disease. Volume overload, which is an important contributor to hypertension in this population, is clinically unrecognized. Adjusting dry weight accurately is central to the control of hypertension in this population. Objective: To assess the safety and efficacy of hemodynamic-guided ultrafiltration on hypertension control and hypertensive heart disease in the ESRD population. Experimental Design: Two groups of patients will be studied: 1) Normotensive patients with normal non-invasive pulmonary capillary wedge pressures will be followed for 6 months. Evaluation includes history, exam, quality of life questionnaires, and pre and post dialysis echocardiography and non-invasive PCWP performed at baseline and 6 months. 2) Hypertensive patients with high pulmonary capillary wedge pressures will have their weight reduced by 2-3 kg. They will be followed for 6 months and have the same procedures for normotensive patients except that questionnaires will be given and PCWP measured frequently during ultrafiltration process. Study Site: Patients will be outpatients at the Gambro dialysis unit on Harrison Avenue.